Update on disease-modifying therapies for multiple sclerosis

2017 ◽  
Vol 65 (5) ◽  
pp. 883-891 ◽  
Author(s):  
Diana L Vargas ◽  
William R Tyor
Keyword(s):  
Multiple Sclerosis ◽  
Inflammatory Response ◽  
Demyelinating Disease ◽  
Jc Virus ◽  
Healthcare Providers ◽  
White Matter Lesions ◽  
Adequate Treatment ◽  
Disease Modifying Therapies ◽  
Oral Agents ◽  
Disease Modifying

Multiple sclerosis (MS) is an autoimmune, demyelinating disease of the central nervous system (CNS). It predominantly affects young women and is one of the most common causes of disability in young adults. MS is characterized by formation of white matter lesions in the CNS as a result of inflammation, demyelination, and axonal loss. Treatment has been a focus of neurological research for over 60 years. A number of disease-modifying therapies (DMTs) have become available making MS a treatable disease. These compounds target the inflammatory response in MS. They work by decreasing the chances of relapse, decreasing the chances of new lesion formation seen on MRI of the CNS and slowing the accumulation of disability. The first drugs for MS to be available were interferon-β and glatiramer acetate. These work by modulating the inflammatory response via different mechanisms that are briefly discussed. Newer agents have since become available and have significantly changed the dynamics of MS treatment. These include fingolimod, dimethyl fumarate and teriflunomide, which are oral agents. Other second-line and third-line Food and Drug Administration (FDA) approved medications include natalizumab and alemtuzumab. Natalizumab is considered one of the most potent treatments for relapse prevention. However, the high risk of progressive multifocal leukoencephalopathy (PML), which is caused by JC virus infection in the brain, tempers the more widespread use of this agent; nevertheless, JC virus antibody tests have helped to stratify the risk of PML. Alemtuzumab, which also has a considerable side effect profile, is likewise highly efficacious. Ocrelizumab, a monoclonal antibody to CD20 on B cells, is a highly effective agent for MS that is likely to be approved soon by the FDA. MS is a major contributor to healthcare costs and it is critical that healthcare providers be aware of the availability and benefits of DMTs. It is imperative that prompt and adequate treatment be established on diagnosis. Changes in therapy should be considered when there is evidence of disease activity as well as accumulation of disability or safety or tolerability concerns.

scholarly journals Case Report: Fingolimod and Cryptococcosis

2019 ◽  
Vol 21 (6) ◽  
pp. 275-280 ◽  
Author(s):  
Rohini D. Samudralwar ◽  
Andrej Spec ◽  
Anne H. Cross
Keyword(s):  
Multiple Sclerosis ◽  
Case Report ◽  
Cryptococcal Meningitis ◽  
Demyelinating Disease ◽  
Opportunistic Infections ◽  
Safety Data ◽  
Pulmonary Cryptococcosis ◽  
Disease Modifying Therapies ◽  
Disease Modifying ◽  
Ongoing Infection

Abstract The use of immunomodulatory and immunosuppressive therapies in multiple sclerosis (MS) has allowed practitioners to regulate MS disease activity, with the caveat that these potent medications may render patients susceptible to opportunistic infections. The approval of fingolimod presented the first oral option for relapsing MS. Since 2015, postmarketing safety data have documented several published cases of cryptococcal meningitis and disseminated cryptococcosis associated with fingolimod use. However, surveillance mechanisms for opportunistic infections and management of active demyelinating disease with ongoing infection have not been adequately addressed. We present a case of isolated pulmonary cryptococcosis with the use of fingolimod to highlight the hurdles in balancing efficacious disease-modifying therapies for MS while treating an opportunistic infection associated with that therapy.

scholarly journals Infectious Risk Mitigation in Patients with Multiple Sclerosis under Disease-Modifying Therapies – the Experience of a Collaborative Neurology-Infectious Diseases Approach

2021 ◽  
Vol 13 ◽  
pp. 117957352110421
Author(s):  
Daniela Ferro ◽  
Beatriz Prista-Leão ◽  
Andreia Costa ◽  
André Silva-Pinto ◽  
Cândida Abreu ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Infectious Diseases ◽  
Jc Virus ◽  
Risk Mitigation ◽  
Latent Tuberculosis ◽  
Interdisciplinary Approach ◽  
Infectious Risk ◽  
Disease Modifying Therapies ◽  
Disease Modifying ◽  
Clinical Records

Background Multiple sclerosis treatment has changed in the last years with the emergence of new disease-modifying therapies (DMTs). Despite a better efficacy profile, these drugs raise concerns about infectious risk, which needs to be mitigated. Objective To analyze the results of a systematic collaborative approach between Neurology and Infectious Diseases (ID) Departments in the management of infectious risk and complications in MS patients treated with DMT. Methods Retrospective collection of MS patients’ demographic and clinical data from clinical records of MS and ID outpatient clinics (2011–2017). Results We included 149 patients: most had evidence of previous contact with Herpesviridae, and half of them were not immune to hepatitis A and B viruses (HAV and HBV). Vaccines for HAV, HBV, and Streptococcus pneumoniae were administered in 91%, 78%, and 88% of non-immune patients, respectively. JC virus serology monitoring prevented natalizumab (NTZ) initiation or prompted its switch in 34/122 patients. Forty patients had latent tuberculosis, in which 88% were treated. Infectious events occurred in 33 patients, mostly mild urinary, respiratory, and herpes virus group infections. Only three patients required inpatient care. Conclusion Facing the expansion of the new DMT, we highlight the benefits of an interdisciplinary approach for safer use of the chosen treatment.

scholarly journals What Do Healthcare Providers Advise Women with Multiple Sclerosis Regarding Pregnancy?

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Annette Wundes ◽  
Roxanna N. Pebdani ◽  
Dagmar Amtmann
Keyword(s):  
United States ◽  
Multiple Sclerosis ◽  
Pregnant Women ◽  
Patient Management ◽  
Healthcare Providers ◽  
The United States ◽  
Positive View ◽  
Disease Modifying Therapies ◽  
Disease Modifying

Pregnancy in multiple sclerosis (MS) is considered safe for both the woman and the child. Nevertheless, pregnancy issues in MS are complex both from a patient’s and a provider’s perspective. In an anonymous survey, 28 healthcare providers in the United States reported on the management of multiple sclerosis (MS) during pregnancy. Participants were asked about their recommendations to patients about the use of disease modifying therapies during pregnancy and breastfeeding and general recommendations about MS and pregnancy. Healthcare providers were also asked about sources from which they receive information about the management of patients with MS. Results suggested that healthcare providers do not discourage pregnancy for women with MS, recommend that women not use disease modifying therapies while pregnant, and have a positive view of breastfeeding for women with MS. Results also indicated the need for guidelines on patient management for pregnant women with MS.

scholarly journals New and Emerging Disease-Modifying Therapies for Relapsing-Remitting Multiple Sclerosis: What is New and What is to Come

2012 ◽  
Vol 4 ◽  
pp. JCNSD.S6692 ◽  
Author(s):  
J. Nicholas ◽  
B. Morgan-Followell ◽  
D. Pitt ◽  
M.K. Racke ◽  
A. Boster
Keyword(s):  
Multiple Sclerosis ◽  
Safety Data ◽  
Treatment Algorithms ◽  
Disease Modifying Therapies ◽  
Therapeutic Landscape ◽  
Oral Agents ◽  
Relapsing Remitting ◽  
Disease Modifying ◽  
To Come ◽  
Relapsing Remitting Multiple Sclerosis

The therapeutic landscape for multiple sclerosis (MS) is rapidly changing. Currently, there are eight FDA approved disease modifying therapies for MS including: IFN-β-1a (Avonex, Rebif), IFN-β-1b (Betaseron, Extavia), glatiramer acetate (Copaxone), mitoxantrone (Novantrone), natalizumab (Tysabri), and fingolimod (Gilenya). This review will highlight the experience to date and key clinical trials of the newest FDA approved agents, natalizumab and fingolimod. It will also review available efficacy and safety data on several promising therapies under active investigation including four monoclonal antibody therapies: alemtuzumab, daclizumab, ocrelizumab and ofatumumab and three oral agents: BG12, laquinimod, and teriflunomide. To conclude, we will discuss where each of these new therapies may best fit into treatment algorithms.

scholarly journals Ethical use of off-label disease-modifying therapies for multiple sclerosis

2021 ◽  
pp. 135245852110302
Author(s):  
Joanna Laurson-Doube ◽  
Nick Rijke ◽  
Anne Helme ◽  
Peer Baneke ◽  
Brenda Banwell ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
World Health ◽  
World Federation ◽  
Off Label ◽  
Disease Modifying Therapies ◽  
The World ◽  
Disease Modifying ◽  
Health Organization

Background: Off-label disease-modifying therapies (DMTs) for multiple sclerosis (MS) are used in at least 89 countries. There is a need for structured and transparent evidence-based guidelines to support clinical decision-making, pharmaceutical policies and reimbursement decisions for off-label DMTs. Objectives/Results: The authors put forward general principles for the ethical use of off-label DMTs for treating MS and a process to assess existing evidence and develop recommendations for their use. Conclusion: The principles and process are endorsed by the World Federation of Neurology (WFN), American Academy of Neurology (AAN), European Academy of Neurology (EAN), Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS), European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), Middle-East North Africa Committee for Treatment and Research in Multiple Sclerosis (MENACTRIMS) and Pan-Asian Committee for Treatment and Research in Multiple Sclerosis (PACTRIMS), and we have regularly consulted with the Brain Health Unit, Mental Health and Substance Use Department at the World Health Organization (WHO).

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